Living well with osteoporosis

In simple terms it means porous bones. Bones, which are breaking down and rebuilt throughout your life, are less efficient at rebuilding as you get older so they become weaker and lose density.

Are you at risk?

If you are female and over age 45 then probably yes. If you meet any of the following factors then you will be at higher risk:

A parent had osteoporosis, was hunched, had fractures or shrank considerably with age

You are of Caucasian or Asian descent

You’ve ever had an eating disorder, have been extremely slender or are under weight

You’ve had irregular periods

You smoke (or have ever smoked) or drink alcohol above national guide lines

You’ve been on long term medication ( steroid/laxative/thyroid/antacid)

You don’t exercise or over exercise

You have digestive problems or are coeliac, or have Crohn’s disease.

You’ve never had children

You had an early menopause

You are getting shorter or have already suffered a broken bone

Testing and drug therapy for Osteoporosis.

If you are concerned about osteoporosis then you may have already consulted your GP, had tests and been given medication. Research in this area is ongoing so it is definitely worth seeking your GP’s advice as to the medical treatment available.

I am not giving advice in this area, but aim to help you manage your condition, or delay the onset through food and exercise.

Theory’s about the body’s acid/alkaline balance.

Scientists and experts do not agree on what we should eat to reduce our risk of OP. This makes it extremely difficult for the general public to make an informed decision as to the best diet to follow. There seems to be two main views on limiting the effect of OP.

One is to follow an alkaline diet, the other to follow a balanced diet including all food groups.

Key points from those recommending an alkaline diet:

·The acid/alkaline balance of our body plays a large part in much of the media coverage of OP.

·It is claimed that calcium neutralises the body’s ph so it uses up reserves to counter the acidity caused by eating acidic food.

·If your diet is acid (more of this later) then your bones will give up calcium to balance the ph.

·With age our bodies do not excrete acid as efficiently so our bodies become more acidic.

·Limit dairy as the acid level can cause more loss of calcium than gain

·Proteins with high acidic levels include red meat, chicken, eggs, cheese, most nuts

·68g of protein daily is much better than consuming over 95g (Tracking your food intake over a few days and using a nutrition calculator such as MyFitnessPal will give you a good idea as to where your protein intake level is)

This advice is at odds with the recommendations of the UK National OP Society for a balanced diet with all food groups. They do not reference the body’s acid/alkaline balance at all. I have not, so far, been able to find any scientific basis for this balance.

As a sport nutritionist I follow the latest research and have a particular interest in eating for good health. In my opinion, a healthy eating plan will ensure that your weight is stable and by adding in a few tweaks for specific issues we can address health issues without ever following ‘a diet’. Find an eating pattern which suits you and which you can follow for life, then you can make changes permanent and, as a result, you will gain the most benefit.

My advice for managing Osteoporosis

Having looked at much material and research I think that a balanced approach is required. Doctors know much more about the science behind our bodies so rely on them for medication. They may not be as knowledgeable about diet and exercise so that is where you need to make your own decisions.

My key dietary points:

·Avoid fizzy drinks, processed food, artificial sweeteners and stress

·Cut down on caffeine, sugar, salt and alcohol

·Be aware that spinach and rhubarb contain oxalic acid which prevents absorption of calcium. I’m not sure how much evidence there is to support this is but there are so many other sources of calcium it seems sensible not to rely on these.

·Increase your intake of green leafy vegetables (list below) they are seen in all the ‘good lists’ for calcium and other vitamins

Why can't I control my weight?

New research from a study conducted at the University of Sheffield has addressed the problem of using a single classification of people who have a weight problem. They are suggesting that this restricts the effectiveness of treatment options. They propose a number of classifications each of which will require a different approach.

Below I have taken their classifications, adapted them to reflect the demographic I see in my work as a physical therapist and then suggest solutions:

Young healthy females displaying the most positive health characteristics.These are typically called yo-yo dieters, they are interested in health and fitness and follow the latest trends in exercise and popular diets. They are able to lose weight quite quickly but maintaining the weight loss over a long period is harder. They join the gym or a fitness class at the beginning of the year but find it hard to keep attending once ‘life’ gets in the way. It’s not their main priority in a busy life so is easily dropped.

For these people, I would recommend a monthly session with a motivational trainer or nutritionist/exercise professional, booked and paid up well ahead. This will keep interest and motivation levels high by suggesting new exercises, new techniques, and help and encouragement in developing healthy eating habits with recipes and nutritional advice.

Males who are unable to control their weight despite having high levels of physical exercise.Lifestyle factors are likely to include high levels of food and alcohol consumption. This group can cover a huge age range from mid-30s to retirement. They may be gym members enjoying a weights based training programme on a regular basis, they may get exercise from dog walking or be golfers. The excess weight comes from the excessive intake of food and/or alcohol and the lack of enough cardiovascular exercise.

I would recommend completing a food diary to capture exactly what is consumed over a month long period. Alongside this find a nutritionist/personal trainer to review the amount and type of exercise. They can then ensure there is enough cardio work to encourage fat burning rather than developing further muscle mass. A tracker to follow activity and monitor heart rate will check actual activity levels. Looking at portion control, meal content and reducing alcohol intake will ensure the best chance of success.

Middle aged females interested in exercise and weight management, although suffering from anxiety, insomnia, depression and fatigue maybe also with low self-esteem.This is another big group, many of whom are somewhere along the menopausal curve. Along with the symptoms listed above, weight gain is common as hormones fluctuate. Previously successful weight and exercise regimes no longer work.

Support during this time is essential, recognizing that many others feel the same way. Exercise classes with a social element offer enjoyable exercise which is more likely to be continued as the people in the class become as important as the exercise content. Community venues or small private centres, rather than big leisure complexes, are more likely to offer this type of class. Look for pilates, yoga and general exercise to music with instructors specializing in this age group.

The affluent healthy elderly, many of whom have high blood pressure.Age was not specified so I’ll assume that they mean 65+ although that’s hardly old these days. I think this group is struggling with their weight as a result of changes in life style and in their body as it ages. Food choices have developed enormously during this group’s lifetime and their affluence can lead to indulgent choices with foods high in fat and sugar. This group of people are at risk, if they do not address their weight issues they will soon find themselves in the next category, ie with chronic health conditions.

This group needs exercise which takes account of their age and high blood pressure as well as a carefully structured eating plan. They also need encouragement and support in keeping to the life style changes required. Exercise combined with a social element is a good solution in this case. Also look for an instructor specializing and qualified in exercise for older adults.

The physically sick but happy elderly with chronic health conditions such as arthritis, diabetes and high blood pressure but low levels of anxiety.This group of people are probably in a vicious circle, the chronic health condition has limited their ability to exercise and this has resulted in weight gain, which in turn adds more chronic health issues.

It is very difficult for these people to keep doing exercise since they have to endure levels of pain to stay active. Unfortunately, without undertaking some exercise, the situation will get worse faster. Basic mobility exercises will get this group into better health, together with dietary advice to cut calories and look at foods which ease the inflammation of arthritis. Small classes designed for people with painful conditions can be helpful, providing support and encouragement from a position of empathy and understanding. Look for an instructor with a GP referral qualification, and ask for a one to one session first.

The elderly deprived who do not have healthy behaviours and have the highest BMI readings.These people are likely to have been overweight with unhealthy diets for their whole life. Exercise will not have featured in their lifestyle, and they may have no desire to change. Any cost of treatment is probably an issue, limiting their choices.

This group are the hardest to help. Approaching GP surgeries to see what they offer is the best way forward. For example they might hold exercise sessions funded by the NHS, they should at least offer dietary advice.

Pain is not as simple as you might think!

Almost everyone will have felt pain at some time in their life. Here at the studio we see a lot of people suffering from pain, mainly associated with movement or a persistent ache. We can usually help to alleviate this either by reducing it or by offering techniques to manage it. What you may not realise is that there may not be a physical reason for the pain.

To get a better insight into what is going on when you hurt, we need to understand how you feel pain.

The ability to feel pain is very important to our wellbeing. It stops us doing things that are damaging to our bodies, and makes us rest to allow our bodies to recover from injury. So you really should not ignore pain, or simply "work through it".Firstly you should make sure that there is not physical damage causing the pain.

The expected mechanism of pain starts with some physical damage which causes receptors within the nervous system to fire. This action creates minute electrical currents which are passed from nerve cell to nerve cell up to the pain perception center in the brain. It is here that these signals are actually converted into what we know as pain. All along this pathway it is possible for your body to mistakenly trigger, sometimes from a sort of nerve memory. Hence, for example, the site of an old injury can often be painful even though there is no damage or reason for that pain.

The brain itself is quite capable of "making up" pain. If you injure your ankle your brain will avoid movements that cause pain in the damaged area. This is good. However once the damage is repaired, the brain continues to avoid movements that were painful. The fear of pain can cause actual pain. The brain has to be retrained to understand that the pain is no longer there by specific repeated movement patterns.

Often in avoiding pain the body will stress another area and cause a pain there. It doesn't always make the right decisions as to the best way of helping your body.We see this type of issue often at the studio. A client may have had a small injury to a back muscle lifting something heavy out of a car (shopping or a child are frequent culprits here). The body's defense mechanism leaps into action and activates a range of alternate muscle actions to protect the damaged area. Unfortunately this will usually cause a misalignment, or imbalance in the body, often resulting in the stressing of and possible damage to a whole set of different muscles ranging from shoulders to knees and ankles.

Clients come to us with a problem in their knee. However, when we have taken a holistic review of their gait and completed a range of movement tests we can see that the problem is not in fact in the knee at all, rather it is a bodily imbalance brought about by a completely different issue.

So, if you have pain, my advice is:Firstly, check with your GP to rule out a structural or other cause which needs medical treatment. Then, come to The Studio for a half hour one to one consultation so we can assess the best ongoing solution. Alternately, or in addition, if you have access to a physio ask them for muscle testing and exercises.

Frequently the solution from me (or a physio) will be regular exercise combined with soft tissue treatment and exercises to include in your existing fitness regime or to do at home.

Pelvic Floor Dysfunction - More common than you might think

HAVE A LOOK ATTHE NEW PELVIC FLOOR WORK - ITAFFECTS MORE PEOPLE THAN YOU MIGHT THINKPelvic Floor Dysfunction: What is it, why do you have it and how can you correct it?

To start with, new research in 2014 shows that 80% of women will have Pelvic Floor Dysfunction (PFD) at some point in their life and 30% will have stress incontinence. Men are also affected by PFD, frequently as a result of prostrate problems, although this is talked about much less.

What is Pelvic Floor Dysfunction?A dysfunctional muscle is one which will not contract nor release so it tends to be both tight and weak, and consequently, unable to function correctly.The pelvic floor is the muscle group which forms the 'under carriage' of your trunk. It supports your internal organs, includes the "bathroom" muscles and adds support to the sacro-iliac joint. So it is essential that it functions correctly. If it is dysfunctional it will be tight, short and weak instead of being flexible, long and strong.

The contributors to PFD include:PregnancyCrunches and sit upsPoor postureWearing high heelsSitting for too long

What is the solution?New research has identified that the pelvic floor will not work effectively in isolation, it will function up to 75% better through a specific mix of muscle group activation rather than with the traditional 'kegels' exercises (controlled lifting of the pelvic floor in isolation).In addition, all exercises should be performed with the pelvis in a neutral position, not in the pelvic tilt position.The specific mix of muscle group activation is to work the Glute (butt) muscles in conjunction with inner, and outer, thigh muscles. This is the key combination for optimum pelvic floor engagement and improved support to the pelvis.

The best exercises are:Squats with correct alignment to strengthen yet lengthen the pelvic floorShoulder bridge with a small ball between your kneesCurtsey or split squatsClam type exercise using fast and slow twitch pelvic floor activationCheck with an exercise professional to ensure that your technique is correct as this is essential to gain any PF benefit. The big benefit of this new approach is that by working this specific group of muscles, correctly, the pelvic floor will activate automatically.

Exercises to avoidAny exercise with a pelvic tilt as this shortens the pelvic floor muscle, encouraging dysfunction.Crunches or sit ups, which increase the downward pressure on the pelvic floor.High impact exercise.Pilates exercises such as 'the 100'

Would you like to know more?Just contact Anne by phone or email to discuss your needs. The correct exercises and techniques are taught in 'I Move Freely' Pilates Classes at The Studio

There is much in the popular press about the benefits of exercise for both physical and mental health.Many people are encouraged to take up exercise by their doctor or physiotherapist.On the other hand, there are many articles about the risk of injury from exercise.For example one study showed that over 60% of runners will pick up an injury in any one year, and another stated that 35% of women exercising on a regular basis will have a musculoskeletal injury.

As a fitness professional and physical therapist I use a variety of techniques to ensure that my clients gain the benefit and do not suffer any injury:

I encourage clients to work at their own level, not keeping up or competing with each other.

I keep a close eye on the posture of each client as they exercise.If there is a postural fault when a client walks in, they will probably keep that faulty position as they exercise.This will be a habit that I am keen to discourage and correct with exercise.

When I spot a common postural imbalance within a group I will add exercises to help them correct it.This could be drawing back rounded shoulders, lengthening the neck or stretching tight hamstrings to encourage better pelvic alignment.

At the beginning of each session I check how everyone is feeling and how long standing injuries are progressing.I will include the best exercises to help each person’s condition.This could be reducing range of movement to encourage stabilization of a lax joint, work to strengthen a weak joint or stretches to help muscles tightened up by other sports such as running or cycling.

Using these methods I aim to help everyone to exercise and gain a benefit whilst not risking an injury.Remember that your feedback is essential to ensuring a safe effective exercise programme so don’t keep quiet about any pain or discomfort as there is usually a way to manage it, and it is often a good indicator to the types of exercise you need.

Exercise - Benfits more than just your body!

When you think about ‘exercise’ you probably think about the benefit to your muscles and cardio vascular system, that it may hurt, you may ache afterwards but you’ll feel better for it and you’ll spend time with a group of likeminded people at your class or in the gym. The first few statements relate to the physical benefits, but the latter are the extra benefits you may not have considered as being so important.

NHS Choices has this to say about exercise and mental wellbeing:

“It has long been known that regular exercise is good for our physical health. It can reduce the risk of cancer, heart disease and strokes. In recent years, studies have shown that regular physical activity also has benefits for our mental health. Exercise can help people with depression and prevent them becoming depressed in the first place. Dr Alan Cohen, a GP with a special interest in mental health, says that when people get depressed or anxious, they often feel they're not in control of their lives. "Exercise gives them back control of their bodies and this is often the first step to feeling in control of other events," he says.”see : http://www.nhs.uk/conditions/stress-anxiety-depression/pages/exercise-for-depression.aspx for the full detail.

So, if you are feeling down, generally tired, depressed or lonely, why not try a regular exercise class?

If you’re not used to exercising particularly in a class, you may think of a number of reasons why exercise is not for you. Often, these reasons are based on misunderstanding or misinformation. I have listed a few common feelings here along with an explanation of what actually seems to happen.

I have never been sporty, so I don’t do physical activity.In fact many of our class members are not sporty in the slightest, and they still find the classes are easy to do.

I always feel tired so class will simply exhaust me further.Many exercises or movement in classes can be made easier or harder by the way you do them. Simply do as much or as little as you feel you can.

Exercise has to hurt to be beneficial, I don’t want that.The more recent thinking by exercise professionals is that “no pain, no gain” is not, in fact, true. In reality we have seen plenty of people who have improved their fitness and personal wellbeing, through exercise, and have not felt any pain in the process.

When I get there everyone will know everyone else, consequently I will be left out and feel awkward.Whilst some classes can be a bit insular, in our experience most class are actually very inclusive. New people are joining all the time and are very soon embraced by the class camaraderie. As an alternative why not take a friend with you?

I have tried yoga/pilates/circuits/whatever and I found it painful/just didn’t like it.Actually, pretty well every class is different in one way or another. The content is usually created by the person giving the class so there are as many different forms of pilates, yoga, circuits, boot camps, meditation, etc. as there are teachers. It is worth trying a number of different classes until you find the ones that suit you. Almost always there is at least one out there.

I have never done any exercise, there are so many different classes I don’t know where to start.In this case, go for pilates or yoga. Look for a class where the instructor tailors content to fit peoples’ ability. Talk to the instructor, or other class members to find out about other classes in your area that may suit you. Then just go along and give it a go. It is normally easy to have a trial at any class and move on until you find one you like. But it is always worth taking to the instructor about any aspect that you didn’t like because it may be that it could be change to suit you.

The fact of the matter is that almost everyone can benefit from joining a class.

If you continue to be inactive you are more likely to suffer from low mood, depression, tension, stress, anxiety and worry.

By taking more exercise you will feel better about yourself, be less depressed, less anxious, have improved sleep and better concentration, not only this, but you will improve your physically capabilities. All great reasons to be more active, particularly the older you get.

Looking at the technical side of why we benefit mentally from being more active there is a combination of reasons, some of which are not fully understood. The simplest factor is that exercise stimulates the release of mood enhancing chemicals, dopamine and serotonin. On top of that the social aspect of common goals and camaraderie have a positive effect, as does the realisation of achievement. Also your support network can be extended, we have found that classes are very good at support and often bring together common experiences and solutions to life’s difficulties.

The key to gaining a benefit is in finding an exercise programme which suits you.

It needs to be enjoyable and an escape from the pressure of ever day life.

It may not be hard work and you should feel able to rest during the class when you feel that you’ve done enough.

There may be a strong social element with interaction with others in the group. The companionship you feel from your fellow class mates can be as important as the actual exercise.

Osteoporosis - A simple guide

What is it?Osteoporosis is a weakening of bones which can lead to an increased risk of fracture

Who is at risk?You are at risk if you: are menopausal, have a family history, have broken a bone, are of slim build, if you endurance train, do not eat properly, smoke, are a heavy drinker, are underweight, are inactive.

Signs to look out forOsteoporosis itself has no symptoms but a fall is more likely to result in a fracture.As it progresses you will lose height, and develop a hunch as your thoracic spine curves.

What can you do about it?Undertake specific exercise to strengthen muscle and improve bone strengthPractice falls prevention, train in balanceMake your diet healthy with moderate alcohol intakeDo not smoke.

Current guidelines for test results for the T score:Normal: -1 to 1Starting to weaken (normal for age): -1 to -2.5Osteoporosis: below -2.5